Home Drug Guide Rolapitant Hydrochloride

Drug Guide

Generic Name

Rolapitant Hydrochloride

Brand Names Varubi

Classification

Therapeutic: Antiemetic

Pharmacological: NK1 receptor antagonist

FDA Approved Indications

  • Prevention of chemotherapy-induced nausea and vomiting (CINV)

Mechanism of Action

Rolapitant is a selective antagonist of the neurokinin-1 (NK1) receptor, blocking the action of substance P, a neuropeptide involved in nausea and vomiting pathways, thereby preventing CINV.

Dosage and Administration

Adult: 180 mg orally 2 hours prior to chemotherapy, then 90 mg once daily on days 2 and 3 if chemotherapy lasts longer.

Pediatric: Not approved for pediatric use.

Geriatric: No specific dosage adjustment; use with caution and monitor for side effects.

Renal Impairment: No specific adjustment recommended.

Hepatic Impairment: Use with caution; no specific dose adjustment recommended.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: High protein binding (~99%).

Metabolism: Metabolized primarily via CYP3A4, CYP1A2, and CYP2D6.

Excretion: Primarily fecal and renal excretion of metabolites.

Half Life: Approximately 7-9 days.

Contraindications

  • Hypersensitivity to rolapitant or any component of the formulation.

Precautions

  • Use with caution in patients taking drugs that prolong QT interval; monitor cardiac function as needed.
  • Alcohol can increase blood levels of the drug; advise moderation or avoidance.

Adverse Reactions - Common

  • Fatigue (Unknown)
  • Hiccups (Unknown)
  • Decreased appetite (Unknown)
  • Constipation (Unknown)

Adverse Reactions - Serious

  • Serious hypersensitivity reactions (Rare)
  • QT prolongation leading to arrhythmias (Rare)

Drug-Drug Interactions

  • Potential interactions with drugs that are CYP3A4 inhibitors or inducers; may increase or decrease effectiveness of other drugs.

Drug-Food Interactions

  • Avoid alcohol during treatment due to potential increase in blood levels.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess patient for history of QT prolongation, electrolyte imbalance, or hypersensitivity.

Diagnoses:

  • Risk for nausea related to chemotherapy.
  • Risk for cardiac arrhythmias related to QT prolongation.

Implementation: Administer as prescribed prior to chemotherapy. Monitor cardiac status as indicated.

Evaluation: Evaluate effectiveness in preventing nausea and monitoring for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed, including timing.
  • Report any signs of allergic reactions or irregular heartbeat.
  • Limit alcohol consumption during therapy.
  • Understand that this medication helps prevent nausea associated with chemotherapy.

Special Considerations

Black Box Warnings:

  • QT prolongation and arrhythmias, including torsades de pointes. Use with caution in patients with a history of arrhythmias or electrolyte disturbances.

Genetic Factors: CYP3A4 polymorphisms may influence metabolism.

Lab Test Interference: May interfere with CYP3A4 substrates testing.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, arrhythmias.

Treatment: Supportive care, monitored cardiac assessment, activated charcoal if ingestion is recent.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable under recommended conditions for the shelf life as indicated on the package.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.